Provider First Line Business Practice Location Address:
SCHOOL OF DENTISTRY, MOOS TOWER
Provider Second Line Business Practice Location Address:
515 DELAWARE ST SE
Provider Business Practice Location Address City Name:
MPLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-624-5249
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2006